You're the Only One I've Told: The Stories Behind Abortion

By Meera Shah

"Moving, multifaceted, and deeply human...as eye-opening as it is compelling" —Cecile Richards, author of Make Trouble

At a time where reproductive rights are at risk, these vital stories of diverse individuals serve as a reminder of the importance of empathy, finding community and motivating advocacy

For a long time, when people asked Dr. Meera Shah, Chief medical officer of Planned Parenthood Hudson Peconic, what she did, she would tell them she was a doctor and leave it at that. But when she started to be direct about her work as an abortion provider an interesting thing started to happen: one by one, people would confide that they'd had an abortion themselves. The refrain was often the same: You're the only one I've told.

This book collects these stories as they've been told to Shah to humanize abortion and to combat myths that persist in the discourse that surrounds it. A wide range of ages, races, socioeconomic factors, and experiences shows that abortion always occurs in a unique context.

Today, a healthcare issue that's so precious and foundational to reproductive, social, and economic freedom for millions of people is exploited by politicians who lack understanding or compassion about the context in which abortion occurs. Stories have the power to break down stigmas and help us to empathize with those whose experiences are unlike our own.

A portion of proceeds will be donated to promote reproductive health access.

• Language: English
• Publisher: Chicago Review Press
• Release date: Sep 1, 2020
• ISBN: 9781641603669

Book preview

Notes

INTRODUCTION

There is no such thing as a single-issue struggle because we do not live single-issue lives.

—AUDRE LORDE

I was walking down the greeting card aisle of a Target in South Carolina, texting and not really paying attention, when I bumped into her. With her gold-rimmed spectacles, wrinkles around her lips, and fluffy white hair, she looked like Mrs. Claus, or maybe even Betty White. She had a warm expression, and she immediately apologized, even though I had bumped into her. In the South, sometimes it seems like everyone is reflexively apologetic. I glanced down at her shopping cart: a bottle of yellow Gatorade, a few pairs of oversized men’s boxer shorts, and piles of unscented Dove soap—maybe fifty bars of the stuff. A peculiar collection of items.

I put my phone away and returned to my original task. The store would be closing soon, so I had to be quick. I was visiting my parents over a particularly toasty summer weekend in my small hometown, and, with very little to do, I used any excuse I could find to get in a car and drive to the air-conditioned Target.

That day, my mission was to buy a birthday card for a three-year-old. Since he couldn’t yet read, I wanted to find a card that played a tune when opened. He would love that.

Are you a nurse? the soap woman asked in her southern drawl.

A bit startled, I responded, I’m a doctor. Why do you ask? Again, I had to remind myself that I was back in the South, where people like to engage with complete strangers. On my way to the store, my parents’ neighbor had stopped his lawn mower just to smile and wave at me as I drove by. I had never met him before.

You have a stethoscope, she said.

I looked down at my bag, and there it was: my black-and-silver stethoscope, peering out over the edge. I had forgotten to remove it while packing for this trip.

If she hadn’t seemed so warm and friendly, I would have chastised her for gendering my profession. This happens to me all the time: a man with a stethoscope is a doctor; a woman with a stethoscope is a nurse. Instead, I smiled at her and turned back to the card selection. I found one featuring Thomas the Tank Engine that made choo choo noises. The woman was still there next to me, looking at bereavement cards. What kind of doctor are you? she asked.

At that point in my life, this question was a tricky one for me. I still hadn’t figured out what to say. As a doctor who provides abortion care and who specializes in sexual and reproductive health, I would often pause when asked what I do, especially when I traveled outside of my New York City home. I’m acutely aware of how abortion is perceived in different parts of the country.

I’m a family medicine doctor, and I specialize in sexual and reproductive health, I finally said. It sounded like a comprehensive answer, yet didn’t give away too many details that could be conversation stoppers. I had just started becoming more vocal about issues that were important to my work and values, and among the many services I provided, abortion was one of the most important ones.

At that point, we were blocking the aisle and had to move to one side so that others could pass.

She wasn’t satisfied with my answer, though. So what does that mean? Do you deliver babies?

Now this made me pause. At that time, I rarely disclosed that I provided abortion care. After the 2016 presidential election, it became a huge focus in my career and a big part of my identity as a physician. While most people in South Carolina believe that abortion should be legal, those same people generally feel that it should only be legal in a select few circumstances.¹ The state’s elected officials have passed several laws that make it much more logistically, emotionally, and financially difficult for people to access abortion care.²

South Carolina is part of the Bible Belt—so the absurdity of these laws makes sense to me in that context. Conservative Christians within the antiabortion movement would do anything to prevent people from having abortions, in the name of religion. Violence against physicians like me who provide abortion care is a very real concern. So much so that it has contributed to the significant shortage of those who provide abortion care. We face a higher rate of harassment and violence, especially in states with more restrictive legislation.³ My friends and colleagues have shared stories with me about being harassed via email, through the mail, or even while walking to work. An antiabortion activist called one of my colleagues working in the Midwest on her personal cell phone, threatening her life and her career. After that, she drove to work at the health center wearing a Three Stooges mask to conceal her identity. Once, when I was a resident training at Planned Parenthood in Colorado Springs, a protester tossed something at my car window. It turned out to be a small plastic baby doll. This is the same health center where, in 2015, a man armed with an assault rifle opened fire and killed three people and wounded nine.⁴ I was alarmed, to say the least.

And let’s never forget Dr. David Gunn, Dr. Barnett Slepian, and Dr. George Tiller—all murdered for doing the work of helping patients that they cared so deeply about.

While many of my colleagues have been able to live and practice in more conservative areas without major problems, most exercise caution when disclosing the nature of their work. Many feel too afraid to disclose their abortion work at all. And most family medicine and ob-gyn doctors choose not to provide abortion care altogether—the fear is just too great, too few residency programs provide training, or the stigma prevents students and trainees from getting accurate enough information about abortion care to appreciate its value.

So, with all this in mind, I felt scared to tell this woman the truth about what I did. Uncertainty came over me there in the card aisle. She was a woman I had met only thirty seconds ago in a Target on a Sunday evening in the Deep South. At that moment, I made so many assumptions about her and how she saw me. I assumed she was opposed to abortion, because of her race, her age, her southern drawl, and where we were located on the map. I assumed she would see me on the other side.

Still, I knew that I had to encourage dialogue and a sense of normalcy around the work I do. I’m proud of it and didn’t want to hide behind fear. Deep down, I believe that remaining silent about providing abortion care perpetuates the stereotype that abortion is unusual or deviant or that legitimate, skilled, intelligent doctors do not perform them. I was now in a position to help correct all the myths about providing abortion care. In that moment, I would be brave. I took a deep breath and replied. I care for people living with HIV and who identify as transgender or gender nonbinary. And I also provide abortion care.

She froze. Her smile turned into an expression of confusion. I panicked. My heart started racing, and my palms were sweaty. Why did she suddenly stop smiling? I wondered. She had seemed so warm a moment ago. What if she makes a scene and someone calls security? I was suddenly afraid that my casual Target run was about to turn into an altercation. I tried to channel my fear into strength and braced myself for what I thought could be a challenging, but ultimately positive, conversation about reproductive rights. I hoped we could at least find some middle ground.

She waited for a few people to pass us, and then she leaned in and whispered, I’ve had an abortion. Long pause. In fact, I’ve had two.

I hadn’t realized I’d been holding my breath, but when the woman finally spoke, I let out a sigh. Now it was my turn to look confused. I hadn’t been expecting this from her and now felt a little foolish for making assumptions. My heart slowed and my shoulders relaxed. My face felt less tense. I smiled at her.

She seemed eager to continue the conversation and proceeded to speak without giving me a chance to respond. The first one was when I was young. Roe v Wade had permitted abortion in all fifty states in 1973. I couldn’t help but wonder if she’d had the abortion before or after. The second one, well, the second one was when I already had two children. My husband had no idea. He still has no idea.

As I listened, I knew I was expected back home, but I wanted to keep talking to her. I wanted to ask her more about her abortion experiences. I see abortions every day through my own lens, but what is it truly like for my patients? I wanted to know what it had been like for her. I wanted to know why she had never told her husband. I wanted to learn more from her. But we would never have that opportunity. We were interrupted by a voice on the intercom. The store was closing soon.

I never got her name. I quickly thanked her for sharing a little bit of her life with me and said that it was nice to meet her and that I wished we had been able to talk more. While I didn’t actually say sorry, I gave her a look of apology for jumping to so many conclusions in my mind.

Before we parted, she got close to me, touched my arm, and whispered, You’re the only one I’ve told.

Ever? I asked

Ever, she said.

I’ve always believed that the simple act of sharing stories is one of the most effective ways to influence, teach, and inspire change. Storytelling creates emotional connections between people. By sharing the nuances of culture, history, and values, people and ideas are united through their stories. Even if an individual can’t identify with another’s exact experience, there is usually some component of the story, even as small as the fleeting, universal emotions of fear or happiness, that can be shared and appreciated.

The movement toward abortion access is founded on stories: stories about people shaping their futures who want to pursue educations and careers, who are able to determine when they are ready and able to be a parent and how many children they can care for. These stories can be compelling—they can help reduce stigma and normalize abortion experiences. However, sometimes the stories with the greatest potential to have an impact on people’s thinking are hidden or kept secret. Many fear that sharing their story will invite shame, disappointment, and sometimes abuse. But more often than not, the opposite is true.

As a physician who provides abortion care, I have been honored to have so many patients place their trust in me and share their stories around pregnancy. I have also been on the receiving end of texts, calls, and emails from friends, colleagues, and loved ones asking me for advice or reassurance about their missed periods and their pregnancy symptoms. I never, ever ask anyone why someone makes the decision they make, whether that is to continue a pregnancy, have an abortion, or pursue adoption. My job is not to encourage or discourage patients to have an abortion. I trust that people know what is best for them. In fact, I believe we need to move past this notion that a decision to have an abortion should be left to the patient and their doctor. I give my patients the most information I can provide and support them in whatever they decide. I don’t decide with or for them.

When I finally came out as a doctor who provides abortion care and started sharing what I do with more people than just that woman in Target, it was like the floodgates opened. Before I knew it, I felt like I became a lockbox of all these secrets. I have become a sudden confidante at dinner parties, at rooftop barbecues, at the grocery store, even at jury duty, when a casual conversation quickly turned into a deeply personal story. Being more open about my work helped people be more open about their own abortion stories.

I couldn’t help but think how amazing it would be if these people could all meet each other; if they could share their stories with one another and not just me. I wondered if I could somehow put them all in a room together and show them that they are not alone. I know that the briefest moment of vulnerability can be the beginning of a meaningful connection, even with a complete stranger. I let myself be vulnerable with the woman at Target, and she then let herself become vulnerable with me. The strength in this camaraderie has the potential to be quite powerful—perhaps even powerful enough to break down stigma and normalize abortion as just another aspect of reproductive health.

That said, I do not believe that anyone should have to tell their story. The burden of breaking down stigma should not only weigh on those who have had abortions. They should not have to teach us about who they are, what their lived experiences are like, and why they have come to their decision. While abortion storytelling can help, everyone plays a role in normalizing abortion.

But blame the patriarchy, stigma, internet trolls, or simple shame—sharing abortion stories freely is not the norm in our culture. When someone does share, they are immediately labeled as brave and courageous. Maybe this is true. Given the hostile climate that often surrounds this topic, it is brave to talk about abortion openly. But I fear that this rhetoric may worsen the stigma as well. Should someone be called brave for doing what they felt was best for them? I don’t think so. But we can say that someone is brave to choose themselves when often societal and familial actors actively try to take away their reproductive autonomy. When someone chooses the health care they need despite the backlash they may face, yes, that’s brave. People should be treated with the same dignity and respect regardless of what decisions they make for themselves about pregnancy and parenting.

People ask me all the time what my typical abortion patient looks like. This question always surprises me, and then I have to remind myself that the stigma has prevented many of us from understanding abortion. If someone is capable of getting pregnant, they are capable of an unintended pregnancy, which may or may not lead to abortion. Pregnancy intention doesn’t always exist in a binary. People don’t always think about a pregnancy as unintended or intended. It may be planned, unintended, or somewhere along a continuum of ambivalence. People who have abortions represent every demographic, socioeconomic status, faith, cultural background, and race. Many were using contraception when they became pregnant; many were not. Some have never been pregnant before; most are already parents. And still others find themselves faced with end-of-life care for a baby they desperately want but who isn’t strong enough to survive outside the womb.

The stories in this book are not intended to convince the reader of the merits of various reasons why people have abortions. While the most common reasons for people to choose abortion are concern for limited resources to raise a child, bad timing, partner-related reasons, and a sense of responsibility to others, the purpose of this book is not to substantiate this data.⁵ There is no such thing as a good abortion or bad abortion or someone who is worthy of an abortion or someone who is not. These stories show that people who have abortions are human beings with varied life experiences, just like everyone else. The decision to have an abortion doesn’t always stem from trauma or turmoil either; sometimes it’s easy and simple. One is not unique because they had an abortion. An abortion does not define someone; it is one event in a person’s life.

As much as I was terrified to tell the woman at Target about my profession, she seemed equally terrified to tell me her story. But once we shared our truths, it was as if an invisible wall had come down and we were able to connect. I’d judged her based on my own biases and fear, and I had been wrong. As soon as I felt brave enough to identify myself openly, a bridge was built and she walked over to me and shared her secret with me. A secret she hadn’t shared with anyone else. I got the sense she felt relief.

I noticed a shift occur in my own personal life as I became more open about my work. My best friend of almost fifteen years pulled me aside one day and shared her story with me. This is the friend I talk to every day, whether about our mutual disgust for cilantro or our mutual love of home decor or our conflicting opinions about The Office being funny.

She told me that when we were in our early twenties, she’d had an abortion. She didn’t tell anyone because while she knew we all leaned toward progressive politics, we hadn’t talked about abortion much, so she didn’t know how we felt about it on a personal level. She went alone to have the procedure done because she didn’t feel she could tell anyone. And because she went alone, she couldn’t receive sedation, which is what she wanted so that she could be more comfortable during the procedure. This brought tears to my eyes. She told me that it wasn’t until I started to speak so openly about the work that I do that she felt comfortable telling me, and eventually others, her story.

We live in a society where most desired pregnancies (and those assumed to be desired), especially within the context of white heterosexual marriage, are celebrated, but the common experiences of infertility, unintended pregnancy, miscarriage, and especially abortion are kept secret. Not every positive pregnancy test is met with celebration. I have provided abortion care to incarcerated people who had no idea when they would be released—having a child in prison and then being separated from that child for an unknown period of time was not an option for them. I have provided abortion care to twelve- and thirteen-year-olds who were victims of rape and incest. A colleague once told me that she was so happy to be pregnant, but when she was sixteen weeks, her husband had beaten her so badly that she ended up in the hospital with multiple broken ribs. She had an abortion because she couldn’t see herself or her child being safe in her marriage. Gender norms, certain sexual behaviors, race, and poverty add further complexity to reproductive narratives. Telling stories about abortion is an important part of a movement toward acceptance of the breadth and diversity of human experience.

As an Indian American woman growing up in a conservative family, I knew that talking about sex, abortion, and miscarriage were off-limits. But since I’ve been open about my work, I’ve had aunties (what I have been raised to call any Indian woman who was around my mother’s age) in the community tell me their stories. One auntie told me her husband was abusive early in their relationship and when she became pregnant, she knew being a mother at that time in her life wasn’t right. So she did what she thought would end the pregnancy—she threw herself down the stairs. While this was painful to hear, I was honored that she told me. Many people don’t feel comfortable sharing their stories out of fear of being judged or because their culture doesn’t hold space for such storytelling, or else they lack the platform.

That’s what this book is for.

My parents emigrated from India in the 1970s. My father is a physician, and after finishing his medical training in the Midwest, he and my mother settled in South Carolina. Education was my father’s priority for his children, as this was the way he made it out of India for a better life. He knew that providing his children with a solid academic foundation would lend itself to further opportunities, but what I felt set my father apart from many other Indian parents in our community was that my father knew that education came from more than just textbooks. We took family trips to other parts of the world; he encouraged me to live and to learn in other countries; and he pushed me to read anything and everything I could put my hands on. Trips to the public library quickly became my favorite part of the week.

Upon entering my freshman year of college at the University of North Carolina–Chapel Hill in 2002, all incoming first-year students were required to read Michael Sells’s Approaching the Quran. Its selection ignited a huge debate that led to a lawsuit from individuals who felt that the university was promoting Islam and forcing religious views on students. The book was not removed as the summer reading selection but was instead designated as optional. When my father heard about this, he was upset by the controversy and insisted that I read the book because he knew the importance of learning about other religions. In fact, we read it together. He taught me that religion is at the core of so many people’s sense of self and that one way to understand others is to try to understand their faith. This idea has long stuck with me, especially in my work. After all, much of the abortion debate is wrapped up in religion and faith. Americans are diverse and they have many different faiths and beliefs. Many people in the movement to ban abortion insist that life begins at conception, making this the core of their argument against abortion. However, many Americans do not share these beliefs. And, more important, when people are faced with an unintended pregnancy, their thoughts are not always focused on the actual abortion itself. The focus is on what impact that pregnancy would have on the greater context of their lives. People often ask what I think about the beginning of life. I always respond by telling them what I know. Medicine can tell us when pregnancy begins and when a fetus is likely to be viable outside of the womb, but the concept of life is more abstract and varies depending on an individual’s belief.

An aunt of mine is Baptist, and, growing up, I would often go to Sunday school with her and my cousins. One summer, I even went to Bible school with them. I’ve read the Bible front to back—twice. I am by no means an expert in Islam or Christianity, but I do have an understanding and appreciation for both faiths and how they teach compassion for others.

My own religious exposure as a child felt more academic than it did anything else. My parents had a small temple in our home, and I often observed my mother doing her morning prayers. I was never forced to attend the Hindu temple in our community or practice rituals that I didn’t understand. My father always believed that one should never have blind faith for religion, that faith should come after you’ve established a concrete understanding of the core principles that religion teaches. It wasn’t until I was entering middle school that I started to become more curious about our religion and ask my parents questions.

My father’s family is Jain. Jainism is a religion that is older than Hinduism and holds three main tenets. The first two are nonviolence and non-possessiveness, or minimalism. The third principle, my favorite and the one that guides my work, is non-absolutism (anekantvada). This is the idea that a viewpoint cannot be 100 percent true; therefore, every viewpoint has to have at least some truth to it. This principle inherently encourages dialogue and harmony with other ideas, beliefs, and perspectives. I latched onto this idea very early on and used it to guide my relationships, friendships, and even my work, particularly around family planning and abortion.

Because of the idea of non-absolutism, I understand and appreciate that some people believe that life begins at conception, or that having an abortion means ending a potential human life. I have heard from family members and colleagues and friends that abortion is a complicated issue because the space that we hold for reproductive health doesn’t take into account the fetus. I do think it’s possible to feel this way and also feel that we can trust people to make the decisions that are best for them and their bodies—decisions that make sense within the context of their unique lives. We can simultaneously believe that there is a potential life growing in a uterus and trust the person carrying the pregnancy to do what is right for them in their own lives.

If the guiding principle in my life is non-absolutism, then my job as a physician is to acknowledge another person’s truth and recognize that our truths may not be synonymous. For this reason, I find it incredibly important to provide both prenatal care and abortion care in my practice. They should not be siloed. Providing solely prenatal care can send a message: I will help you if you continue the pregnancy, but I won’t if you don’t continue the pregnancy.

Several of the storytellers in this book have had multiple abortions. I understand that the idea of having multiple abortions can make some people feel uncomfortable, even to those who work in health centers that provide abortion. Often it is hard to separate our own lived experiences from those we are caring for, no matter how hard we try. We sometimes find ourselves thinking that we would not ever be in a situation where we would have to have an abortion, let alone multiple.

Once I was leading a workshop on values clarification around reproductive health for some medical residents (doctors in training). I asked them to tell me how they felt about a patient having multiple abortions and not using contraception. The responses I received included irresponsible and lazy. I asked them if abortion was unsafe. They said no. Then why is it bad to have multiple abortions? Is it because abortion is bad? They said no as well. But they still couldn’t tell me why the idea of having multiple abortions didn’t sit well with them.

I then told them that my grandmother had seven children. How was she different than someone having seven abortions? One person raised her hand and said that it’s because my grandmother wanted to have those seven children. I asked them how they knew that. No response.

I reminded these residents that just because someone continues their pregnancy does not mean that it’s not fraught with trauma, poverty, abuse, missed educational or career opportunities, violence, or food scarcity. My grandmother did the best she could with her children (two of her seven children died within the first year of life), but she and my grandfather did not have much money and the entire family lived in a one bedroom flat in India. We don’t know if she was able to plan her family the way she wanted to. We don’t know if she wanted to work or to go to school. We don’t know if there was any coercion or abuse going on. And we don’t know if she had any access to contraception. We just can’t assume things about people we don’t know much about.

I’m sometimes asked by patients about sex selection. I have had some patients, mostly of Indian descent, in the United States tell me that they want an abortion because they can’t have another girl, that it would be burdensome to the family. Truthfully speaking, this doesn’t sit well with me. But I have to remind myself—it isn’t about me. What makes me uncomfortable is the deep-rooted history of male preference in Indian culture that has perpetuated layers of inequalities that often lead my patients to these decisions—not the actual patient asking for the abortion.

Sex selection is a practice in some parts of India and China. In the United States, I’ve only seen a few cases of this because it’s not very common at all. Nonetheless, some states have taken actions to prohibit the practice. The Indian government has even tried to ban sex selection by making sex determination through prenatal sonography illegal. In 1994, the Preconception and Prenatal Diagnostic Technique Act was passed, but it has failed to create much change in rural parts of India. The preference of boys is ingrained in some cultures in India, and I sometimes see this unfold in my exam room as well. If I deny someone an abortion because I don’t agree with them not wanting a girl, I may be worsening their situation at home, worsening the outcomes for that patient and their family. Denying someone an abortion to make a statement about morality is ignoring the root cause of the issue.

I also understand that our faith and cultural backgrounds contribute to and potentially complicate our views of our bodies. Growing up, I was always told that young girls and women shouldn’t go to the temple or attend religious ceremonies if they were menstruating. It was felt that you were dirty if you were on your period. I never quite understood this, and I still don’t. I remember being young and asking my aunt once how God could have created periods and then told us to not come into his home if it was that time of the month. It didn’t make sense and she said she couldn’t explain it.

I very vividly remember attending my childhood friend’s wedding while I was menstruating. It was a festive and colorful five-day Hindu wedding. I gave the bride a hug when I saw her, and then her sister overheard me asking someone for a tampon. Her sister berated me for hugging the bride on her wedding day because I was dirty. In her eyes, I had disrespected the bride. The rest of the day, the bride and her family members avoided me and wouldn’t come anywhere near me. The shame I felt that day lasted for years.

If I had been at a non-Hindu wedding, I would have had a different experience. The fact that I was on my period probably would not have mattered. What I learned from this experience was that every culture has a unique language for talking about and perceiving their bodies and menstruation. At my friend’s wedding, touching the bride when I had my period was bad, it was unlucky. And

Reviews for You're the Only One I've Told

[Hannah Smith · Rating: 5 out of 5 stars]

I absolutely loved this book- started reading this when the SCOTUS leak happened and it was so good. It’s informative without reading like a science book. It gave a voice to people from all different walks of life with their own reason for getting an abortion. I feel it should be required reading for all people who can get pregnant regardless of their political views